prepared to vote democratic. they are enthusiastic about running. i think the 70 points is correct. it is historically high. the generic numbers, democrats ahead of republicans by 17 points. i think that is amazing but not necessarily surprising given the environment which has been created in the country. part of whatust steny hoyer had to say earlier today on newsmakers. he is interviewed by the washington post and bloomberg news. watch newsmakers sunday at 10:00 and 6:00 p.m. on c-span. next, a senate hearing on opioid addiction in the u.s.. samnalist sam keown is -- recently wrote a book

on the opioid epidemic and testified on his research and what he has learned in the course of writing his book. this is two hours. ,> our witness is sam quinones author of dreamland, a true story of america's opioid epidemic. senators will each have five minutes of questions.

since he is our only witness, if he wants to take more than five minutes to say what he wants to say, we would welcome that. , it is unusual to have a single witness at our hearings and this is an unusual topic, one you say the washington post is going the worst man-made epidemic in history. the challenge this crisis presents has captured the attention of every member of this committee. your research and writing has been acclaimed for its depth and rep -- depth and breath. this is a bipartisan hearing, one in which democrats and republicans have agreed on the topic and its importance. this is one i hope we will restrain from lecturing each other about health insurance and focus on the topic -- the opioid crisis. this epidemic kills more americans each year than car accidents. we are reminded of that almost

every day. yesterday i jumped by meeting at the tennessee governors wrote -- tennessee governor's residence in nashville. doctors were planning how to discourage the over prescription of opioids. the governor told me that in our state of 6.6 million people, there were seven point 6 million opioid prescriptions written in 2016. even though the state has reduced the amount of opioids prescribed, the number of overdose deaths is up because of the abuse of fentanyl, a synthetic opioid. timer than spend more establishing the crisis, i want to focus on what we can do about it. there are does go things i'm hoping to learn from you. things i amtwo hoping to learn from you. why is it not a good idea to continue to find the so-called

holy grail of medicine, a nonaddictive pain medicine? the second -- if stronger communities are the ultimate solution to this crisis as you often suggest, what can a central government in washington do that helps? you have a question, chapter in your book entitled searching for the holy grail, finding a nonaddictive pain medicine. i have read your book. i think there are a number of others who have and you brought it with them. this search for the holy grail began in 1928 with a committee on problems with drug dependence. that was the goal, as you describe it. could not the best scientists find a way of extracting the pain killing elements of the morphine molecule while discarding its addictiveness? this effort to find a better way to treat pain led to a revolution in attitudes toward pain treatment.

first using opioids to relieve pain for dying patients, then patients with chronic pain, then abetted by mexican gangs, clinics over prescribing doctors, spiraling into the addiction and consequences we find today. congress, dr.his francis collins has predicted that the holy grail that was first sought 75 years ago is now within reach. last month, he said perhaps within five years. with our encouragement, dr. collins has organized researchers to speed up the process. the fda commissioner was on board to fast-track the effort within the bounds of safety and efficacy. i read at least some of your book to say this holy grail may never be found. you even quote some scientists who say it should not be found. i hope you will tell us what you think about this.

should we not continue to try to find nonaddictive pain medicine to relieve suffering? is that not the obvious antidote to the opioid epidemic? the second area i would hope to learn from you is what we can do from washington, d.c. we have tried to address the ravages of this crisis which we have all experienced in our states. passed thengress comprehensive addiction and recovery act and the 21st century cures act to give states and communities the tools and resources they need to combat this crisis. for example, a provision by senators warren and cap ito was included -- and o was included only fillies can parts of prescription, that way a mother filling her sons pain prescription could ask only for three days worth of pills instead of the 30 days worth of

pills he was prescribed. in addition to encouraging the moreopment, cures included than $1 million in state grants. we are considering additional funding for treatment and to discover alternative pain medications. we have held hearings on wellness, lifestyle changes, which you mention in your book, such as exercising, eating healthier, that help people lead healthier lives. what incentives would help people make those lifestyle changes? you and i have one thing in common. i'm a skeptic of washington's capacity to solve problems that are problems of communities, families, and lifestyle. you say the opioid crisis is a problem of society, that when we use -- when we lose our sense of community we become easily -- easy prey for external solutions. moreur words, "i believe

strongly than ever that the antidote to hair when his community -- make sure the people in your neighborhood do things together, break down the barriers that keep people isolated." it is my own --erience in public life i've been convinced of the problem-solving ability of communities where everybody seems to be interested in the well-being of everybody else. whenever i've tried as governor or senator to solve a problem, it has boiled down to creating an environment where communities could themselves fix problems, not sending in singles shot solutions. after spending years on state reforms for education, i ended up traveling the state to create a better schools community task force because i believe communities who wanted good schools could have them and those that did not would not. same views as we

fixed no child left behind in 2015, when we restored more decisions to teachers, school boards, and states. what does congress do from washington, d.c. about this opioid crisis? this committee has jurisdiction over a significant amount of what you have written about in "dreamland," but not the spending of money. that belongs in the appropriations committee. we are eager to hear your testimony. murray? , thankrray: sam quinones you for joining us. i also want to welcome your wife and daughter. i'm glad they were able to be here with you today. i look forward to hearing your perspective on how we can better help our community fight this

crisis and support all of those that have been impacted. -- i appreciate the investigative work you have done to help shed light on this challenge. i am sure you agree the rise of this epidemic is broader in scope than anyone book can tell. there are people from every background and corner of the country that have stories about the harm that this has done. have lostarents children, children who have lost parents, veterans in chronic pain who are struggling with addiction, doctors who are treating babies born addicted to opioids and a lot more. heartbreakinghese stories first-hand traveling around my home state of washington and meeting with doctors and families fighting this disease. i was visiting a local hospital in longview, a community in my state and the staff told me that almost one out of every two babies born have mothers who struggle with substance abuse. that was astonishing and heartbreaking. it was not the only evidence of

this epidemic. 2000, nearly 10,000 people in washington state have died of opioid overdose. this is not just happening in longview, it is happening in hospitals across the nation. we are losing 91 people every day to opioid overdose. when i say this epidemic means everyone, i do not just me the opioiduals facing addiction. there are other victims as well. hurts families, at least children struggling to cope with the impact of their parents addiction. it leaves parents shattered with the heartbreak of their child illness and many struggling with the financial cost of opioid recovery. our epidemic hurts communities. it takes up resources of public health hospitals and law enforcement. it takes workers out of our local economy, it takes a toll on the morale of small towns and big cities alike.

we are behind the curve on fighting this epidemic. one of the stories that stood out to me in your book was about a state employee from the washington department of labor, a woman named jamie. she was a pharmacist charged with overseeing the cases of workers who were receiving prescription drugs for injuries. she noticed that some of these workers were dying from the same painkillers they were prescribed. the paper she published in 2005 about the uptick in opioid prescription and debts was one of the first papers in the country to document the impact of the crisis we are now facing today. she published her paper over a decade ago, which just shows we have been fighting this battle far too long and we have to do more. i am glad we have taken some necessary steps. in 2016, congress passed the whichentury cures act included funding for states to address the opioid crisis.

the comprehensive addiction and recovery act, which supports specific outreach for veterans and postpartum women, and expanded access to medicaid assisted treatment and much more. there is a lot more to do. along with many of my colleagues i hope we can move more funding , firstupcoming budget responders, state and local officials, treatment officials and families have made it clear that continued federal funding is the key to addressing this crisis. have heard a, we lot of clock from the administration but we have yet to see the president take the kind of serious action that this emergency demands and that he promised families on the campaign trail. own counsel of's economic advisers estimating the economic crisis -- economic cost of the crisis to be over $500 billion just for 2018.

addressing a problem this big will take an enormous investment of time and energy and robust funding. our communities are crying out for serious solutions, not stunts. i am eager to see this committee continue its bipartisan approach and to take expansive action to a dress this epidemic over the next few months. i look forward to working with you, mr. chairman, to have all our members move ideas forward so we can work on policies for our communities. this means immediately providing supplemental funding states needs to implement evidence-based tools that can help turn this epidemic around and we need to make sure local stakeholders and partners who know what works best in their communities have the resources and information they need to respond to this crisis. it also means going beyond prevention and treatment and recovery.

we have to work to support not only the individuals facing addiction but the families and communities who are suffering. i am interested to hear your perspective. i am grateful for you coming here today. if we are going to beat this opioid addiction, we have to fund and enact solutions that are comprehensive as the challenge. thank you for having this hearing. i look forward to working with you and all our members. >> thank you, senator murray, and thank you for working in this way to have such an important hearing. i am pleased to welcome sam quinones and his family today. thank you for taking the time to be here. he has 30 years experience as a journalist and author. he has written extensively on the opioid crisis. he is the author of three acclaimed books, and his most recent book, "dreamland -- the true tale of america's opioid

epidemic" won an award for general nonfiction. early in his career, sam quinones was the recipient of a -- of the oldest international award in journalism for his work covering latin america. he was also the recipient of an award for outstanding print journalists who pursue stories in the public interest. will have 10, you minutes to give your testimony and then the senate is looking forward to having a conversation with you. go.quinones: there we clearly i am a rookie here. chairman alexander, senator murray, and honorable members of this committee, i would like to thank you for these hearings on our national epidemic of opioid addiction and for allowing me the honor of addressing you. i am happy to be here with my wife and daughter, who are part

of producing "dreamland" and without whom the book could never have been finished. this is the deadliest drug scourge we have known in this country, hitting areas of the country that have never seen this kind of drug problem. it is the first in modern america to be spread not by mafias, not by street dealers, but by doctors overprescribing pain pills, convinced they were doing right by their patients, urged on by the pharmaceutical industry, by the medical establishment, and urged on by american health consumers who wanted a quick and easy end to pain. ofs could not have dreamed inciting the kind of torment and death we have visited upon ourselves through this overuse of opioids. these drugs are a symbol for our era. we havest four decades

exalted the private sector, the individual, while we ridiculed government as an efficient, incompetent, and wasteful. we admired wealthy business, regardless of the way they made -- regardless if the way they made their money produced anything of value. we brought a second gilded age. this epidemic of addiction to a class that thrives on isolation reflects all that. this epidemic's cost have been borne by the public sector while the profit has been private. i believe this scourge is about than drug deeper addiction. it is about the effects of this cultural shift and isolation in areas rich and poor, about the hollowing out of small-town america and the middle class, ization of our society.

it is a culture that acts as if buying stuff is the path to happiness. i believe we got into this because we believed problem's be attacked in isolation with one magical silver bullet. a pill for our pain, a jail cell for every addict. we have exalted the public and the communal and rid ourselves of things so essential to us they have no price. we have been invaded by cheap junk as a result. and replacedamland it with a strip mall, did that across america for years. heroin is what you get when you destroy dreamland. i believe isolation is heroin's national habitat. i believe this epidemic is calling on us to reverse these decades of isolation and come together as americans. i believe more strongly than ever that the antidote to heroin

is community. people coming together and working in small and local ways towards solutions. no one saving the world alone. the good news in all this is that there is no solution -- there are many solutions. much bell, each tinkered with an improved, some may be discarded. each must be funded fully and for a long time. the good news is none will do the trick alone. i believe that across america today, communities are finding new solutions. themore they band together, more they leverage all that talent and energy, bring in pdas , pastors, librarians, the chamber of commerce.

the more cops and public health nurses that go out for a beer -- bridge the cultural chasm between them. i believe this is happening in counties across america. that supply has ignited all of this. we did not have this addiction until we unleashed a large supply of powerful legal narcotics on the public for the last two decades. is essential that doctors reassess how and to whom and in what quantity they prescribe these drugs. cuttings not mean people off who are on high doses of these drugs and leaving them to fend for themselves. it does mean lobbying insurance companies to reimburse for pain strategies that do not involve narcotics, allowing doctors a wider array of pain strategies than simply pain pills. doctors need more education in the med school in

both pain management and addiction treatment. delusional to spend time and money on another wall along the u.s./mexico border hoping this will stop the supply of heroin and fentanyl. these areas are coming in through areas with wall already. corrodee a wall will the only thing that will help stop these drugs from flowing into our country. that is a deep, respectful, but also forthright and want -- and relationship with mexico that will lead to it becoming the kind of neighbor and partner effectively and become the kind of neighbor that country needs of us. another wall seems just like heroin. it feels good for the moment but it will leave us in a worse place in a long run.

another silver bullet for a complicated, adult problem. sometimes the solutions are about the monday and mechanics of governing. we should find new ways of -- and corridors expanding our national force of forensic pathologists. this epidemic spread because some of those offices are so poorly funded. we must expand treatment options in this country. one place to do this, crucially, is jail. consider how the country will be helped transform and jail into a place of nurturing recovery, instead of a place of predation and tedium. it becomes an asset instead of a liability and this is happening, particularly in the state of kentucky. i would also like to add that all across america are families who are suffering due to the addiction of a loved one or the

loss of that loved one. i believe they are raw materials to be harnessed in this fight. many who do not want to be involved need to be involved. to stop the wounds that will last a lifetime. i believe you senators can help this by recruiting them and giving them platforms from which to tell their story. i am at is because reporter, but i believe that through their stories, the awful stigma of addiction will be reduced. i am happy to elaborate on any of this. before i'd do that i want to urge you to view this as an opportunity. view this as an opportunity to revive those regions hammered by globalization and free trade. the roots of our natural epidemic of narcotic addiction lie there, while the epidemic in itself lies in the way of their revival. many of these regions cannot

revive until enough of their people can pass a drug test to fill new jobs. of drugnot only a story addiction, it is a story of economic affliction. your naturals, response to a crisis like this is to look about for things you can do quickly to show your constituents you are taking action. that is understandable. i would caution against short-term responses. make up a great start and i thank you for them, but they are only a start. everything i have learned about this issue has taught me the importance of long-term, community responses and commitment. i believe a history offers two templates for action from which you might take guidance and inspiration. planirst is the marshall to rebuild europe after world war ii. the second is our space program.

each involved government and the acting inctor concert, bringing in money, brain, energy, and long-term focus to bear. -- eachieved and achieved a good for our country. they were about doing things that seemed far beyond our own short-term self-interest. the marshall plan was about building up ravaged regions to allow them to function independently, while containing the spread of soviet communism. countries toboard prosper and contribute to the world again. a marshall plan for american onovery might focus rebuilding those regions that have been caught in dependence on dope and ravaged by economic devastation, to contain the spread of addiction. program, wespace were inspired as a people to spend years and dollars to achieve something no previous generation ever thought possible

-- we ended up far beyond the moon. in economicr benefit, increase in knowledge, and in simple human inspiration is beyond calculation. it seems to me that we might profitably apply these examples, the marshall plan and the space program to regions of forgotten america where this problem began. let us do it not because it is easy, but, as jfk said, because it is hard. because that is what americans do and have always done at their greatest. like our space program, i believe such an effort will have to last for years to be effective. focus far beyond the immediate goal of drug addiction and on the more profound problems of community destruction and the halloween out of -- and the h ollowing out of stretches of this country. i urge you to see this not as

the cassette -- not as the catastrophe it is but as the gift it could be. it allows you to reinvest in areas that need it most, a chance to inspire us as americans again to something great. it is an opportunity to bridge that political polarization that gnaws on our country. it is one of the few issues that can do that. do not miss this opportunity. it does not come around often. this calling is the very reason many of you got into public service in the first place and you're lucky to be here when it has. you will be remembered for acting when acting was not easy to do. , your hometown's will thank you, and we, your countrymen and women will thank you long after you're gone. happy to talkm

about anything you guys want. to have a begin now five-minute round of questions. thetors, try to stick to five minutes because we have lots of senators that want to ask questions and i will be glad to stay for a second round of questions. senator paul? : the book was great. when you write a book you're not sure how many will read it. desks, i copies on the am sure at least half of our committee has read your book. that is why you're here. as i read the book, i was reminded i used to visit my grandparents in pittsburgh, it was built in the 30's, 100 yards long with a slide in the center. you can see how the community was surrounding that swimming pool. as i read the book, i tried to

think what we can do better or change. is idea that big pharma lied a part of the book and a part of the problem. they were punished, but we need to make sure people cannot lie. some of that can be federal, some of that can be state law. i continued to become more and more alarmed that our profession was part of the problem. we have tried to fix it. in kentucky we have done a lot of things -- you can type in and find out if they're seeking different doctors. we have gotten rid of the bad doctors, the doctors you mentioned. they are mostly gone. are no longer in kentucky. we have a county in kentucky that has 21,000 people. last year they had 2.8 million doses of oxycodone. everybody knows it is a problem. more people are dying that are

dying from car accidents. it was worse last year this county. they prescribed more. since medicaid expansion, it is an 11% increase. when we look at what we do, let's say, let's have a marshall plan. we need to think about how we spend the money and what we do. we wanted more people have health care so we expanded medicaid. if you look at the expansion of medicaid and you look at that map overlying the united states, you have a map of the heroin epidemic and the opioid problem. in your book you can talk about -- you do not have to pay $200, you can pay three dollars a month and you can get it and traded. we do have to -- you can get it and trade it. we do have to have new rules. i think the hard part is the chronic. if you're been on it forever for low back pain, how do i get you off it. do you just choose another doctor if i take you off it?

that is the problem. we all know the knowledge. people have read your book. they know there is a problem out there. we have made changes but we still have this enormous prescription problem. what do you think we do beyond that. i agree that more local than federal is probably better, but we still -- how do we fix the medical aspect of this, how do we go a step beyond where we are? mr. quinones: that is a massive question. there are smarter people than i who might contribute to it. i think one of the reasons you find a correlation between heroin overdose and medicaid expansion is because more access to medical care means more access to pills. we stop not changed the basic culture. one of the reasons for doctors to prescribe pills as a solution

. it seems to me that the crucial in all this is we get back to what we're doing in the 1970's, and that is where insurance companies were reimbursing a wide array of strategies for pain. they have cut back significantly in many areas. for a long time at the was all across the country. some insurance companies are stepping up more. to me it gets back to what the doctor has available to him or her in the appointment at the point of contact with the patient. that feels like a crucial step. every place i go to speak on this topic, i run into doctors who tell me they do not have much in the way of other options to provide. paul: the hard part is i live in a country -- in a county

where we have 4% unemployment. there is not enough workers. then i have counties were 30% of people do not work and 30% of people are disabled. in my county 4% of people are disabled. we all have big hearts and people say let's help the unemployed, and then we give them stuff. but perhaps once you become a permanent non-worker, it gets you into this cycle where it is much more difficult. we have to figure out how to do it with a heart and a brain where we have work requirements and your only temporarily -- until youl your are back in the workforce. we have to be careful with how we do it so we do not have reverse incentives. you can see the time clock we have on the senators, everyone will be very interested in long conversations. we are going to try to wrap each segment up in five minutes and then we will keep going as long as we can.

senator murray? senator murray: thank you for your compelling testimony and thoughts. the federal government plays a critical role in tracking this hasemic and in some ways brought capacity and reach. it uses innovative ways to get timely data. the public awareness program started under the obama administration back in 2016 to raise awareness of the opioid

and personalizes and disseminates messaging. has repeatedly requested cuts to cdc's budget. you have mentioned we need quality data for raising awareness. can you tell us about the necessity for funding programs like that? mr. quinones: i would suggest the evidence shows it is probably a good idea. i would also say we need to greatly expand the amount of money we provide for research for addiction as well as pain management, pain treatment. all this is part of all these many solutions. when i talk about the federal government's role in all this, it is in no way to suggest that it has a dominant role.

i believe the important stuff that is often going on at the the role of the federal government might be to -- theate their lives important stuff is often going on at the local level, and the role of the federal government might be to facilitate, make easier their lives. when i was doing this book, i found almost nobody who wanted to talk about this, except for government workers. this was the first line of defense in this, when nobody really knew about the topic and nobody really cared. when i thought i had bitten off an enormous contract to write a book and put my family in jeopardy for a story no one cared about, the people who did care, who were working on this from the beginning -- cops, coroners, cdc, public health werers, all of whom

working for a public salary. i believe the folks at cdc do remarkable stuff. i am a crime reporter. did not write a word about health care until i wrote this book, and might overall feeling e for our public health folks -- my overall feeling. they have done amazing work. senator murray: you have written about the importance of medicaid as a key to part of responding to this crisis. 1.6 million previously uninsured people with substance abuse disorders get the health they need to fix this through medicaid. can you talk about the importance of medicaid? mr. quinones: medicaid expansion

provided drug treatment for people who did not have it, hundreds of thousands of people in different states. it is extraordinarily important, i think. i know people in different communities who has been in nor mostly helped by this. i do not want to downplay what senator paul was talking about, which is that you do have an increase in overdose when that happens. i think one reason for that is in too many communities, pills medicall the only treatment -- senator murray: an important part of that is also supporting mental health and everything else. mr. quinones: of course. when you get more access to health care, there are other things that come along with it. one thing that does come along with it is a reliance still to this day on these pills. we have dropped our prescribing, but it is still at about 2006

levels, and almost triple what it was in the late 1990's. that to me means we probably still rely far too much on these . that said, i do not understand the impulse to strip away medicaid expansion, particularly in areas where this problem is so intensely felt. to me, it feels like these are regions that desperately need the services provided through medicaid expansion with drug treatment being primary. collins: first of all, let me thank you for writing .uch an important book what has been discouraging to me is despite much greater public

awareness and much more money and much greater intentions, that the problem does not seem .o be getting much better one possible community-based in "the was described morning sentinel," a paper in waterville, maine, and it struck with me because law enforcement officials in my state tell me that their jail intake rooms resemble hospital emergency room's. what some police departments in watervilleuding in and scarborough and other areas are doing is they are telling addicts that if they come in with their drugs and turn them in, that they will place them in treatment facilities.

this is a whole different approach for law enforcement to take. rather than locking people up, helping them to get the help that they need. it is also very community-based, as you have suggested in your book. in your experience, have you seen that type of program work better than the traditional approach? mr. quinones: first of all, in reference to your first point, i think we need to keep in mind that this problem has been festering for 20-plus years. .eople come to me all the time we have been at this for a year and a half or two of years. that as ao me culture, we need to learn patience and to not believe in silver bullet answers to mysterious problems like the mystery of human pain.

this have not solved problem in the last year and a half to two of years, i would say we just need to keep working at it. long time for these things to exist. with regard to law enforcement, in general, some of the most innovative folks and innovative things i have seen come from law enforcement. you would think law enforcement would be holding on to the old ways of locking people up. i have been amazed at the innovative ideas coming out of law enforcement. the one you mentioned is one of them. one i mentioned in my written testimony is about the transformation of jail. i believe if we come out of this with a new kind of jail, the way the jail is run, as you see in the state of kentucky two doesn't just doing this -- two

doingt -- two dozen jails , we are better off. today, jail is a liability. people want to make a change and we put them in a place that is tedious, predatory, ganged up, sexual stuff going on -- all that kind of baloney. the positive stuff i have seen one in particular in kentucky, are remarkable. it is where you are working on your recovery from the morning -- the moment you get up at 8:00 in the morning and make your bed military style to 11:00 at night when lights go out. that kind of change would be enormous. in my testimony, i tried to highlight things that would not just be beneficial for this

problem before the next drug problem as well so we are not playing whack a mole with this. thelieve jail is one of great places of effervescence, you might say, when it comes to the way new ideas are being tried. i have never been to maine, but it sounds like what you are highlighting is one of those. i do believe it is an essential part of this, that if we come out with jail the way we always used to run jail, we will not really have advanced. the next problem will hit us and we will wonder why we are not making great advances. it is not a revolutionary idea. you can find various examples of its around the country, and is very invigorating to see. senator collins: thank you. senator casey: thank you, mr. chairman. , thank you for your

testimony and your work on some of these issues. i want to start with the realities at least i have seen in a state like pennsylvania. we have had 4624 overdose deaths in the last year, up 37% from the prior year. in rural areas, it is almost 10 percentage points higher by way of an increase. that is overdose deaths overall, obviously a lot of that being driven by the opioid crisis. i missed some of your testimony going back and forth between hearings, but what i see in pennsylvania is a tremendous resource gap. when we went across -- when i went across pennsylvania this last year, especially this past summer, we would have meetings inh county officials, often

small, rural counties, small-town counties where you have an ad hoc group of people coming together. you have the mayor of a small town, police chief, the coroner, the medical professionals, treatment professionals all around the table all the time meeting every week because the dead bodies keep coming in. one small county said to us maybe the most graphic metric was they did not have enough places to put bodies. that is how bad the problem was. it is everywhere. what i keep hearing from folks at the local level is, "we need more resources. we are getting our arms around this, dealing with it as a local community, but we need more resources." they certainly did it for community workers, social workers. the first thing i would ask is what recommendations do you have for closing that resource gap?

even though the federal government has made some strides, as you know, what is the sense of the way federal government can provide more resources? mr. quinones: speaking with people in the country, this is one of the great places in america where things are taking place. is one ofn america the most effective areas. i have been struck over the last year, year and a half to watch these organic task or committees or whatever you call them sprout up in county after county. , i was in ania county, home of williamsport with a held the little league world series -- where they held the little league world series. these folks are coming together in very healthy ways, seems to

me, leveraging a lot. there's a lot of different folks. speaking with the president there recently, she said one of the problems is they can find money for programming but cannot find money for the nuts and bolts that make it work like office space. that kind of stuff that is as essential if not as sexy as the other stuff. to me, that is where the federal government needs to step up. the acts the federal government half past are wonderful, but we have been overprescribing for 20 years, creating addiction unintentionally -- the acts the federal government have passed our wonderful. in comparison to what the country needs, it is in every state.

it is an unprecedented problem because it is in every state in america coast to coast. i am suggesting the evidence shows there is a need for sustained -- i'm talking years' worth -- sustained investment in , i think, thinking in terms of -- for example, this more mundane idea of how to let their job be easier -- well, fund the office space, the telephones, things like that. later, we can talk about the issue of corners, but to me, that is a crucial part of this as well. i know it feels like a lot of money. it is a lot of money, but not compared to the breadth and time of thisgth of problem. seems to me that this needs to go for some time now. >> thank you for that. i know we are out of time. i actually introduced a bill to

commit $45 billion over 10 years . i borrowed the idea from, of all places, a republican version of the repeal of aca where they were setting up a separate fund, so i took what i thought was a good idea and made it into a different bill. we're hoping we can get support that will be bipartisan, but we appreciate your testimony and commitment to these issues. mr. quinones: my pleasure. thank you for having me. you foryoung: thank being here today. thank you so much for writing this important book, and i appreciate your visit to indiana to visit with us last week. i would like to discuss our children. thousands of children across my state and around the country are having their lives turned upside down on account of this epidemic , not because they are addicts, per se, but because they are being removed from the home. their parents have become addicted. they are entering an already overwhelmed foster care system.

you have identified in your book the need for more services for families. can you elaborate on what specifically -- what sort of programmatic needs there are for families or resources, in your experience, that might help mitigate this crisis? i would like to say you would probably be best off talking to people who work in that field. one of the areas that has been devastated is foster care. there is so much need now. if it were not for grandparents in america today, i mean, it is just mind-boggling to think what the need would be. so many kids are living with their grandparents now because their mom and dad are either gone or in prison or what have .ou my feeling is on a blunt, basic,

macro level that we need to look .t how to fund more foster care how to do foster care better is likely another great question, but it is not one i feel i can answer. >> your larger point -- senator young: collectively, many of them fall under the banner of community. if we can persuade individuals that a fellow human being's plight, a fellow child's hardluck is actually their own plight, then we can entice more people to be foster parents, to lobby on their behalf and so forth, so i think that is a good, overall message i have taken away from your book. we have already discussed jails.

in your book, you highlight some jails that offer rehabilitation , and peculiarly, in peoplereas, you have putting himself -- themselves into the criminal justice system just so they can get assistance or their friends or relatives doing so. i would like to discuss a different sort of setting. i used to represent in the house of representatives austin, indiana. we know that name because have a huge hiv outbreak on the count of intravenous issues of an opioid by the name of opana. many communities like that around indiana. i have a strong suspicion that

their inmates have either hiv or pepsi or something else -- hiv c or something else they might typically test for. if they test these individuals, they are legally on the hook to provide medical services to them, and in a place like got county, indiana, that would deplete their entire law enforcement budget for a year if many of them tested positive -- and a place like scott county, indiana. number one, have you encountered this dilemma? if yes, do you have any thoughts ? i do not doubt it exists. nothing surprises me anymore about this topic, i have to say, ited -- but i do not doubt exists. all i can say is this seems to be the nature of this problem,

-- another asking case you just mentioned, a jailer to be, again, the thisians, to figure out social problem, and i don't think they have an answer for. they do not have an answer for, nor do they have the funding. sometimes i am a reporter. sometimes i just have to say i don't know. honestly, sometimes it gets to the point where i am just overwhelmed by all the ways that this problem manifests itself. i do believe locally is the place where we find the solutions, but that you all have an absolute role in facilitating, making sure that they have the resources they

need. on the ground, i have to say, ie people in those counties have been to are working very .ard and very imaginatively you going to them and finding seems to me, need, the evidence would show the way we proceed on this. most of theseve solutions emanate from rushing to an, d.c. i believe the federal government in helpingund role facilitate those solutions. -- i do not believe most of these solutions in the nate from washington, d.c. >> very much appreciate you having this hearing. sam, it is nice to see you. one of the most compelling pieces of nonfiction i have read in a long, long time, and it is very, very depressing, the story

you tell about something we have not really talked about, which is the heroin epidemic that wrote on the back of the prescription drug -- i mean, you just tell it brilliantly. my reaction reading it was this was all happening in plain sight, but somehow we missed it. year are,000 people a dying from this. the white house estimated this is costing the united states economy $504 billion a year. $1 billion is a lot of money, but it is .2% of what it is costing our economy. the rural counties in my state -- now this is not just about rural counties anymore, but the rural counties in my state, you go and the sheriff tells united 2% of the people he is admitting 92% of the people he is admitting in his jail are testing positive for heroin.

,r he opens a window and says "there are women in my jail. i have never had women in my jail." we are spending 42% on targeted treatment. local person, i am all about the local community, but they cannot do it without resources. to,rural communities i go if anything, have less access to treatment than they did 10 years ago. it is striking that we are moving in the wrong direction. lot tonones: there is a comment on. one of the problems is with our overprescribing of these pills, we in time created legions of addicts, and that in turn awakens the logistics potential of drug trafficking culture.

i lived in mexico for 10 years and i know it's very -- i know it fairly well. heroin is viewed as a disgusting drug and people are far more .namored with meth and coke they did not really want to traffic heroin or get involved too much with it. now, of course, that radar is at a very high level and they want to get involved, and it has exploded the numbers of people who are trafficking it, so that is one thing. believe thatore, i the community is where it seems to me i have seen people working hard and coming up with solutions appropriate to their counties and their regions. i do not believe they can continue long-term without a lot more help and, as i said,

sustained long-term focus from the federal government. i believe a lot of folks are looking to the federal government, republican and democrat, right-wing and .eft-wing, in this fight for sustained help, not one off. : can you talkt about the ways in which health insurance reimbursement create challenges for people at the local level? you write about the inability to get low-cost social worker, for example. right.nones: initially, in pain management, for many years, pain management was to take one individual and inign over a period of time close connection to the patient and the doctor together, design

a menu of strategies that would help just one individual. manyndividual, many, strategies. marital counseling, diet, acupuncture, on and on like that , physical therapy, etc. job counseling. as we began to believe that one pill or drogue would be the solution to all pain, insurance companies dropped a lot of that and you could not really designed a full panoply of strategies because you were no longer getting reimbursed for a lot of that. to me, i think that is fundamental in this whole problem. doctors need to be more educated, but they also need to have the tools. as doctors, we're told there is a pain epidemic in this country. there's a big reason why we got

into this. my belief strongly -- and this comes from talking with lots of doctors about their dilemmas -- it is to find that they need more solutions. by the way, v.a., hats off to them. they were a leader in all this, and now they have done a u-turn, and you can get yoga, acupuncture, etc., as well as some dose of opioid painkillers. not to say that these drugs have no use. they are absolutely useful in certain windows, but -- so i think we are seeing these kinds of changes. it seems to me the reimbursement for different kinds of pain strategies is just a fundamental part of this. : welcome andwski thank you for your leadership on

this issue and really raising that level of awareness. as you point out, this has been out there for a while, but i think my colleague just mentioned it has been growing in plain sight. thank you for knology there is no one silver bullet -- thank you for acknowledging there is no one silver bullet. it is a complicated problem, and as we all know and as you mentioned, it is not just an adult problem. our children are dying of overdoses. our children are suffering because the parents are checked out. i sat with a group of primarily senior leaders and asked if i were not here having lunch with him today, but they would be talking about, and they looked , "where we would find services for our grandkids. all of us are taking care of our grandkids because our kids are either in jail, given up the kids, whatever."

this is truly a problem that consumes all ages, all spectrums, all classes. i'm interested in your suggestion that we need to look at this from a very broad perspective and really strive high, that the marshall plan follow the same lines as the space program. the problem i see with that is we are still suffocated, that isd by the stigma attached. it seems like it has just been recently that you will see in an obituaries that there is acknowledgment that this young person or this individual died from an overdose, but we have aried it because there is sense of, "i failed as a parent if my kid died from a drug overdose." until you get beyond the stigma

-- i think there are still so many that are like, "those are the ones who just could not make it. those are failures, losers," which is a horrible thing to say and i even hate to say it in front of a microphone, but there is that stigma out there. so how do we get people galvanized to help and to be inspired to do something as big as -- i agree with you -- this needs to be in order to make that difference? are we making headway in reducing the stigma? yes, greats: question, senator. thank you for asking. definitely, we are. in 2013, i was writing this book, and i had a conversation .ith my wife i said that the book would die when it came out because nobody in this country cares about the

problem. i could not find anybody that wanted to talk about it except for public health nurses, the occasional narcotics officer. one of the main reasons was that familiesr family's -- were mortified, embarrassed. this is a different kind of problem than existed in the past . people were embarrassed by what had happened to their children, and you never ever saw an obituary that told the truth. like the aids issue early on. "well, he died of cancer." in this case, it was, "well, he died at home of a heart attack at age 25." what helped to change that, similar to the gay marriage issue, which is a radical change in public attitude over the last 20 years, is getting to know people who are actually affected . i know you heard a lot about how you need to provide more funding for stuff, but i do believe you

have a public profile role as senators. find those parents, talk to them, point out the programs, with those county groups sprouting up all over the country. it is amazing to see those. meet with parents and say, "thank you. tell us your story." recruit them. frequently, a lot of folks would go a long -- go along or do that if asked. as i said in my testimony, maybe it is because i am a reporter, but i believe in the enduring power of stories to change people's minds. as human beings from prehistoric times to today, we have always to helpories -- stories us understand. the reason this was not very well-publicized ears ago and

hidden was because the people who could best tell the story did not want to talk. now, increasingly, they want to talk, and it is so important to embrace them, to bring them out , and with that, my feeling is there is a horrible stigma, exactly as you say, and one of the main ways we stories.at is through i believe as public officials, you all could have a magnificent .ole find those parents, bring them out, have them talk a little bit about their lives, recruit them, give them a call. herelet them know we are together. so many of them felt alone. they made horrible, bad mistakes because they thought there was

nobody else nearby, that they were all alone in this, and i think defeating that isolation is part of the many, many solutions that have to be tried. >> thanks, senator michalski -- senator murkowski. we have several senators remaining who want to ask questions. senator murphy is next. senator murphy: thank you very much, mr. chairman. if one of us were to go down to the senate floor and give a speech on loneliness, we would worry it would come off looking silly, and yet, if you look at a map of the suicide epidemic in this country, the crisis is the worst were social isolation is the greatest. if you read peter early us great book about the mental health crisis in the country, he comes

to the end that the only effective mental health solutions in the country are the ones that build connections between people -- if you read great book about the mental health crisis in the country. complicated one. it was a private, low-cost community pool that closed circumstances outside the government's control. kids had lots of reasons to state inside, houses had their own pools. you hint at being critical of the decision by the government to let that pool close. they could have spent taxpayer money to keep the pool open. probably would have been criticized for throwing away money, but the result might have been that a community asset might have stayed open.

i guess, let me sort of take you from where you left off in your testimony. you focus your book on this question of building community. we are really awkward when we try to address the ways in which community can build and attacked loneliness because it sounds like something we are not supposed to do. and yet, at the heart, this is something we should be thinking about. the way we build communities rather than try to tear them down. mr. quinones: the best idea i can come up with is to consult the people who are already working on that. all across the country, that has happened. that is one other thing that has changed, that we have now on the ground lots and lots of people

working on this and a variety of ways. my feeling as a reporter is always to go there and ask them, thealso understand government has, it seems to me, and essential convening role. by providing the infrastructure together.bring people that includes stop signs and good roads, that kind of thing. but also, funding to provide, you know, the community centers and this kind of thing. talk moreu guys might about that on the senate floor, honestly. i think it is not a conversation we have enough in this country and you all might be the ones to perhaps lead it. honestly, we would all be inspired if you did. my feeling, anyway. i would be. -- how dou do that

you do that? i am a reporter. i do not know all the ways. my impulse as a journalist is to go to those areas, talk to as many people as you can, and also highlight them. find the people who are working hard. find those community coalitions, forcesask or sis -- task . your presence at one of their meetings would be huge. try that. try to be there with these folks and understand and see. will it be a pr event? probably. who cares? you want to highlight these are the folks working -- and from that -- that is how innovation works, right? on the factory floor, you have the factory worker, the supervisor, the computer software guy, the accountant all putting their brains together and finding little incremental

ways to make that product better. cities and towns work the same way. wand.ic bullet, no magic just slow, incremental work. senator murphy: if we are going to spend a lot of money on this epidemic, it is worth challenging us -- mr. quinones: absolutely. planbelieve in the overall . somebody asked me about the details. i don't have a clue. i am just a guy, a reporter out there trying to understand this in or miss country we have, and sometimes it's hard. senator murphy: thanks, mr. chairman. -- trying to understand this enormous country we have, and sometimes it's hard. >> that the pretty good description of how we feel. mr. quinones: i that you do.

>> i want to ask you about your chapter "the holy grail." why is it not a good idea to try to find nonaddictive pain medicine? mr. quinones: my friends from college would look askance when i say this, but as i got into this story, i began reading philosophy for the first time in my life, how we create happiness. it seems like all these people all across the country are looking to this substance, one form or another of opiates to be happy, at least for a few hours. -- there aree that a few ways the philosophers i read talk about working hard toward something that you are fulfilled by, that you are excited by, that you love to do, and along the way comes the fulfillment that we call -- >> if i may interrupt, in your you talk about how first

opiates were to help people dying who were in horrible pain. , erroneously,red that it might not be addictive, so this whole revolutionary, you treating pain, then they turned out to be addictive, but just because opioids turned out to be addictive, is that not a reason to try to find other -- mr. quinones: i would never stand in the way of science. long run, that in the we are humans, and humans have never done well when they have it all. when they have all the pain treatment and none of the consequences. this is a hunch. i'm not saying i know, and it 10 years from now science has come up with a pill that produces all

pain to negligible amounts and does not budget anybody, i would be thrilled and happy for those people who benefit. put words innt to your mouth, but it sounds like wereould suggest if that possible, it might be good, but it might only be one strategy. mr. quinones: i believe other strategies, given the fact that we are humans and need tension in our lives to actually be productive and be happy, i believe there are other things that need to happen in american culture. when i was writing this book, i stopped drinking sodas. i wanted to be the change that i wanted to see in the country, so i stopped eating food i saw advertised on tv. i felt that it was important to do things that would reduce the

been. that i would have i have no problem doing research trying to find a pill that would be completely pain killing without addiction. i just have a skepticism that in the long run we would as humans be able to handle it. that some problem would -- we behave very poorly -- kings, dictators, hollywood producers, apparently, these days behave very poorly when they have no other friction in their lives, no accountability. senator alexander: yesterday, i dropped by the governor's residence, and he had a meeting of all the people in the state at universities in charge of training physicians, with the goal of changing their attitudes toward prescribing of opiates. one of the health officials said to me when i told him that i

would be hearing from you today to ask about fentanyl and where it fits. so, in 50 seconds, can you tell us about that? fentanyl has transformed the heroin market completely. it has democratized it. used to be harrowing you knew came from four or five mexican you knew camein from four or five mexican states. now it can come from anywhere. it used to be the way you got customers was overdosing your clients. that was not a warning. it was an advertisement on the street. a lot of folks ran to find the dope that killed that person. now, you want to cut because it gets you more volume. you get a kilo and cut it into get more out you

of it, but it's weaker. fentanyl has made a far cheaper to od people and therefore around your -- buzz product. it is a diabolical thing to explain, but that, it seems to me, is the nature of this thing. it also has allowed many people to get involved in this. by the dark web, -- it is coming from mexico but also is being sold on the dark web. thank you for: holding this hearing. thank you, mr. quinones, for being here and for your work. at the outset, i would say some of the themes you have touched on today about community are also themes that the author and sociologist robert putnam has touched on. mr. quinones: absolutely. yes. senator hassan: i think your

book and his together are really important. i want to start by laying a little bit of groundwork. i was governor of new hampshire starting in january 2013. i am also a governor who works with the republican legislature to implement medicaid expansion, which was implement it in the middle of 2014 -- august, i think. in 2013, we had 192 overdose deaths in new hampshire. in 2014, 326. we were on an upward trajectory, even before medicaid expansion. one of the reasons we all came together to implement medicaid expansion is because we had a crisis in our behavioral health and drug overdose deaths in our state and we knew medicaid expansion would get more treatment to people. my own anecdotal sense that medicaid expansion did not move int caused an increase opioid deaths is cause for a

recent article in "health affairs," so i want folks to have a sense of that. i think there may be a correlation there, but to suggest there is a causation is very troubling to me. i also think it speaks to some of the stigma issues that you have talked about. i do also want to thank you for your insistence that this is a problem that was decades in the making. it is going to be decades in the subtle and it requires approaches and approaches that can evolve with the way this epidemic is evolving. to the chairman's point, fentanyl in our state has the way lawt in enforcement and the treatment community address this. i thank you for your advocacy for that. i want to spend a little bit of time on one of the issues that i don't think we have touched on as much right now as it deserves.

in your book, you chronicle the so-called porter and jake letter, a 1980 letter to the editor of "the new england journal" which was completely byinterpreted and used pharmaceutical companies to play their product was essentially nonaddictive. it is astounding that one paragraph jotted down in 1980 helped fuel the horrible epidemic we are seeing today. your book outlines how drug companies have played a bigger role and how some have misled patients, providers, and public officials about the addictive nature of their products. can you give us a brief overview of the role of the pharmaceutical industry in creating the misconceptions about that letter? mr. quinones: brief? hassan: you have one minute and 45 seconds. mr. quinones: it shows it was

pivotal in all this. it starts with pain specialists believing we were poorly treating pain, and we were. this is the story of a lot of people doing what they thought was the right thing, but doing too much of it turned out ed lee. i do not believe they would have had the megaphone that they came to have were it not for a lot of the money and funding and the use -- the selected use of their information by pharmaceutical companies. i think their money and influence would really change the tide, and then, of course, they were joined by certain , but i think they triedrly on that they had , only foreased opioid cancer patients, and it was a

magnificent drug. if they had just stuck right there, we would be applauding them. theead, what they saw was dying cancer patient market was pretty small and there was a much, much, much larger one called chronic pain or just normal pain of americans, basically. and they got on board. this was also, by the way -- an important part of this was that -- theears involved industry went through a sales force arms race where every company was hiring more and more and more sales reps, and these were not the older sales reps who were really more grounded in fact. it is my impression talking with doctors who knew these older fellows -- mostly guys -- that these guys knew what they were doing and were not such a hard sell. then you hire a bunch of young folks, and a lot of good-looking , sog folks to inundate pharmaceutical reps went from

something like 35,000 to over 100,000 in about a five-year period. thisf that also is part of story also. this is a complicated tale, and i wanted to not blink at the complications. i believe also we as americans play a huge role in all of this. our desire to have quick and -- pain, to not be accountable for our own wellness. hassan: i will not have time for a second round of questions, but i will say in my state, the need for funding to support the grassroots efforts is critical, and i look forward to talking with you more about that. thank you, mr. chair. kaine: thank you, mr. chair, and thank you, mr. quinones. "dreamland" and "factory

men" are the two best works of reporting i have read in the last few years. we have had witnesses here, and i have asked them the questions -- could we set a goal addiction free by 2030? i am mindful of your point that there is no so verbally, but i am also mindful if you do not have a target to organize on the move,ll be we will rebuild these economies and enable them to protect themselves. if you do not set the target, you do not marshal your resources around meeting the target. if you were to advise us about what the target would be -- again, i pose the question to these folks, could we set a target of addiction free by 2030, and francis collins and scott gottlieb said that is doable if you define it the right way and it is doable within the current scientific

knowledge and technologically likely new term future, but if you were to give us a target, what would you tell us? mr. quinones: if i were to give you a target, we would all be in trouble. i would say that a target is good, and it is my hunch as an american that that is something to strive towards. it is always good to have a deadline, always good to have a goal, what that year should be and if humans can ever be a is debatable. i'm not sure that is possible. as i said in my testimony, to me, this is a supply story. i lived in mexico for 10 years. not having thought about it very deeply, i just adopted the idea that all our drug problem was demand-driven. senator kaine: there is a lot of evidence for that. you addressed a street corner dealer, another one pops up.

demand is going to keep producing streetcorner dealers. mr. quinones: i agree, but the primer and all of that i believe is supply -- the primer in all of that, what starts it i believe is supply. it is a bi-national drug problem . it really need to be addressed, us and them, but as i started writing this book, i realized we had no real problem before this oversupply of opiates. the difference is the supply did not come from columbia dealers and mexican guys from senna loa well-trainedom doctors buying into the idea that they could help their patients by just massively prescribing these pills.

one,oal is a lotta bowl but to my way of thinking, there is -- supply is the issue. their, i, to get believe requires that -- you know, there's a reason why all those guys from vietnam came back addicted. first of all, they are no longer .n war-torn vietnam they are in rural tennessee. there was no supply. addicte you separate the from the supply, the better chance that addict has of success. that was what they found in portsmouth, ohio. senator kaine: i have a brother-in-law, dwight holton. mr. quinones: i know him well. i was going to say thanks. wonderful guy. dwight has told with this many times -- if there

was a social movement for the recovering, it would become the most powerful political movement in the united states. he is grappling with the issue of how you get over the stigma, and to and republicans, red state, blue state, this recovering social movement would be massive. mr. quinones: again, i believe in the more stories you tell, the more people end up -- this happens to me on airplanes all the time. i start talking about the book i just wrote. they ask what i do for a living, and i tell them, and they will look around like this and under their breath, "well, my cousin s going on five years --" whatever. the more those stories come out, the more we know how many people around us have this issue in their lives, the more it becomes a way of you don't have to lower your voice anymore. it becomes natural. x.overing from

it normalizes and it makes us all understand that this is actually something going on all around us, and it is an amazing thing to have written a book like this and then go on the road and have those encounters in airports and things like that. i believe in the power of story, as i said. senator kaine: i am over my time, but i really appreciate you being here today. senator alexander: thank you, senator kaine. senator warren: thank you for your research on the rise of prescription opioid use. book, you write about a hospital in columbus where a medicaln the adolescent department helping heroin addicts get detoxed talks about the kids he was seeing who had started with prescription

he said it wasd all of them. that was how all of them had gotten started with prescription painkillers. a story that is true, i take it, for far too many americans. according to the cdc, people addicted to prescription painkillers are 40 times more likely to be addicted than to heroin -- addicted then to heroin. many who misuse the prescription pills, start off with pills that were legally prescribed. i know you were started off with prescription opiates when you're appendix was removed. do you mind saying more about that experience mr. quinones: sure and i think my story is multiplied by millions every year for 20 years. i had an appendix rupture at

work when i was at the l.a. times night shift one night and i didn't realize it, went home, went to the hospital later and they said my appendix ruptured. i spent two days in the hospital and was a perfect example of what to do and what not to do. each of the two days i was in the hospital they gave me two vicodin, very good idea, i just had been cut open, good idea. and then when i left, they gave me a bottle of 60 instead take as needed. again i am a crime reporter and i've done work on games and gangs and stuff like that and i'd never written about health care. i didn't know, not really paying attention to this issue at all i didn't know what vicodin was, i thought it was a glorified aspirin because they told me as i left, take as needed. okay that sounds like aspirin to me. i don't like taking pills, so i took two of them.

senator warren: you got 60 leesville. 60 of these pills. mr. quinones: they the remained of my medicine cabinet for four years and i said i think i still have that. i knew what it was and sure enough, we found it and disposed of it. but again, a couple things. that is a perfect example of the supply that we have unleashed on this country. multiply my case by millions of people and you get to where we are. there is actually some data on -- senator warren: there is actually some data on this but that found that between two thirds to 92% of patients who underwent various procedures like you did reported that they end up with unused opioids afterwards and just like you a lot of them stood out in the medicine cabinet and can then fall into the wrong hands. very easily.

as senator alexander noted earlier, last congress senator capito and i passed a bill to try to tackle this problem by letting the patient's request only a fraction, only a day or two worth of their opioid prescription to be filled at the pharmacy and if they are still in pain a few days later they can get a few more pills if that's what they want to do. i know it's not coming you talked about how complex this problem is but i want to talk about it one little part. mr. quinones: i think that's exactly the kind of thing i'm talking about, the small solutions, many small solutions one of them is to take that kind of supply out of the medicine cabinet of america basically and i think also to get doctorsgive doctors in the habit of questioning i think it was routine for years in this country to just prescribed 60 or 90 of these pills and give doctors out of it. think of the windfall by the way a pharmaceutical company when a

doctor in a white coat prescribes you 10 times more than the pills that you need and you like i did say okay. or in your case, 30 times more. and there's refills and so on. again, i get back to the basic dichotomy here. it's a story built on bbc in a magic bullet solution. i think that there's lots of little things and what you're outlining sounds like to me one of those little things. senator warren: i just want to say on this, we got the law passed here but that doesn't make it a reality, so we have sent letters, senator capito and i come to every governor in the country come, the different medical organizations asking them to back us on the implementation of the partial fill. and also, here we are more than

a year after the wall has changed and the drug enforcement administration still has a definition on partial fill that is out of date, not in compliance. just a couple of weeks ago senator capito and i along with senator grassley and senator feinstein sent a letter to the dea to ask them to update these regulations, so as you said a complex problem. we've done our part and we need to get if you proceed in line with this. >> thank you senator warren. senator baldwin. senator baldwin: i really appreciate you being here today. it's my pleasure. what an opportunity to have a conversation and so you chronicled this epidemic as having its roots two decades ago at least and yes, we find ourselves still scrambling and losing ground. i represent wisconsin and the new front of this battle.

appears to be fentanyl. in a community like milwaukee county, fentanyl was the cause of deaths combined with other opioid overdose is about 420 in that county last year. it's just one example in the state of wisconsin. and at this point, there is no sense that 2018 is going to be a turnaround. despite the fact that milwaukee county has a very committed here

when task force and leaders from the local law enforcement and leaders from health providers have been collaborating to address this. i wanted to sort of dovetail on your conversation with chairman about synthetics like this sort of changing this epidemic in some way. we need to be prepared for a next generation of synthetic opioid and what is the federal role in assisting communities? mr. quinones: that is a huge question i think and i'm not sure i have all the answers. senator baldwin: i have a couple more huge questions for you. [laughter] mr. quinones: there's nothing but huge questions on this topic seems to me. yes, fentanyl has been remarkable and transformative. it's like the third stage, pills, heroin and fentanyl.

and carfentanil, which is rhinoceros painkiller. it is my belief strongly having lived in mexico that it is calling on us to understand that the only way we are going to talk any kind of an effect is by working with mexico, not at odds with mexico. there is no way you can stop the smuggling, but we a alone can stop the smuggling into the united states because of his so small. a sugar packet worth could kill everybody in this room, so and probably on this whole floor. so my feeling is one thing that seems to be extraordinarily counterproductive in my opinion having lived in the country for a long time is the rhetoric i'm not saying it is put on rose-colored glasses. i've lived there and they know the issues and the corruption and depth of the problems that

they have but never the less, in a person-to-person connection which we never have achieved as government to government from what i can see, that is how you advance. they just shut down. it was an interesting case in july. they shut down the marketplaces in july of last year and they did with the fbi and it with the fbi and some others i think. it was a classic example of how you make a huge dent in the supply by working with these governments, global economy copy only groups that don't work together in the governments and that was one example i thought was fascinating is how you move forward, and to me those are the ways that you help local law enforcement. being in local law enforcement today feels like you are standing in the ocean trying to take back the tide. i'm going to ask a question but

i don't think there will be time for an answer. maybe we can follow up. senator baldwin: i'm going to ask a question but i don't think there will be time for an answer. maybe we can follow up. i have held a lot of roundtables with stakeholders from recovering addicts, family members who've lost loved ones, law enforcement health etc. around the state you talk so much about solving this through the ending isolation and having stronger communities. i do find some significant variation between what i hear in urban centers in wisconsin and what i hear in rural areas come everything from the availability of resources to help people who want to get treatment even to what drugs are being taken and abused. i would love to hear your

thoughts. i'm not going to be able to stay for the second round, but perhaps a follow-up in helping strengthen communities and all those different settings as they respond to sometimes unique and sometimes common challenges. >> thank you, senator. senator collins: thank you, mr. chairman. i wanted to explore further with you the link between economic affliction and drug addiction that you refer to. many of the communities like portsmouth, ohio have been devastated by mill closures for example. you said heroin is what you get when you destroy dreamland and you said that isolation is the

natural habitat. in the state of maine, the opioid crisis appears to have started decades ago in washington county that borders canada and it is an economically disadvantaged counties very high rates of unemployment and a lot of isolated communities. it then spreads everywhere in maine including our most , prosperous towns and cities. the portland press herald last summer ran a ten part series on the opioid epidemic and it focused one story on the lobster industry highlighting the high entry rate in that industry and also the logistical challenges of securing treatment in the rural communities.

it's a great story. i've read it. they will be interested to know that. mr. quinones: tell them i tip my hat. senator collins: in your investigation, did you find that drug dealers tend to target communities that are economically devastated, are they more fertile ground for addiction? mr. quinones: i didn't notice that. i don't think drug dealers are deep sociologists. i think they are following the money coming into the first place this begins his economically devastated because teenpain treatment and resorting to doctors was part of how you navigate economic disaster. you get disabilities as we were talking about earlier.

you have people who are trying to navigate and to get that, you need a doctor and again, this seemed as time went on the it became something to result to a substance. you get pills and you can solve them and people figure that out. some of the first dealers were seniors, they were not young people at all, they were seniors that figured out that kids will buy this stuff and so the rest. i do believe as you said that this is it starts in areas with deep economic affliction and in the areas that are viewed as kind of the losers and the great free-trade we had over the last 30 or 40 years perhaps. now of course that made me change my view of the story charlotte north carolina,

banking center, very wealthy country clubs and mansions, they have the problem as that problem as well and i think that it is into some larger questions of the as americans how we view pane and what we want to deal with. senator collins: i want to follow-up on your comment about the horrific role that is played by grandparents. i held a hearing in the committee to look at this issue and grandparents raising their grandkids due to the opioid crisis. just as an important statistic i will tell you that in my state, between 2010 to 2015, the number of grandparents taking care of their grandchildren and being solely responsible for their care soared by 24% and it's

because of the opioid epidemic. i think that is what is happening. i think that story is repeated in many states in the country. senator collins: thank you for your good work. >> senator murray, do you have additional questions? senator murray i just want to : thank the witness for being here today. your name has been pronounced a lot of different ways. [laughter] can you pronounce it. mr. quinones: quinoes. [laughter] [laughter] it's been pronounced to me in numerous different ways through my life. senator murray thank you for : your excellent work and i look forward to working with you and all of the committee members. >> thank you. senator murkowski has questions and then we will wrap up the hearing. senator murkowski so many : statistics you have cited in your book but one that floored me was the reference to the

volume that goes in the united states consume when it comes to narcotics. you state that the united states consumes and they are writing 83% of the votes oxycodone and 99% of the world's hydrocodone. gram for gram a group of specialists wrote in 2012 people in the united states consume more narcotic medication than any other nation worldwide. okay, so people can become addicted whether you are a u.s. citizen or some place in south america, what is it about this

country that has us at only 99% of the world's hydrocodone and vicodin? what is it that has happened here? senator collins: -- mr. quinones: that is a terrific question and one that began to hit me as i got into this book and realized it wasn't just a story about a drug addiction but who we've become as americans. senator murkowski: the united states as drug addicts. mr. quinones: two generations ago or so, about a million people joined the army and the whole country participated in defeating the nazis and now we can't get our wisdom teeth out without getting massive doses of opioids.

i mean, i sought the answer to that. what is the common denominator between words of ohio, a town battered by almost every economic force the last 30 years in charlotte north carolina which is a very wealthy town, salt lake city and these towns have done very well. what is the overriding common denominator? it isn't economics obviously. you have two very different economic situations. by way of feeling is that it is a combination of isolation and also frankly maybe this was an essay on the dangers of prosperity that too much stuff given to freely people are not expecting. everybody fearing that its scanning their their anemia due their knee may do keeping them outside for keeping them indoors and all across the country. but is it interesting to you that those that were doing the senator murkowski: but is it interesting to you that those that were doing the deliveries didn't use the stuff. mr. quinones: they were addicted to something else.

senator murkowski: they were addicted to the resources that came back. but you look at that and say what is it about americans that has pushed us in this direction in such an extreme direction? you have other countries that have the same issues that we have. they have economic decline, isolationism, the same things that we have come and get me have turned to opioids to done -- numb it all. we focused on the individual and mr. quinones: we focused on the individual and great ideals of american kind of experiments that have become twisted and the pursuit of convenience and be entertained us with self-reliance isfor self-relianceis this idea that becomes isolation. accountability becomes tantrums

whenever any political official or cop or doctor doesn't exactly what we say it seems these are things behind of what behind a lot of this but maybe we have had too much. we've become pampered in some sense. i don't pretend to know at all. these are questions that i'm fascinated by and i would love to talk about them but i make no claim to know all the answers to these questions you are posing. senator murkowski: so, this statement was made back in 2012 in the journal of pain physicians. would you assume that those numbers have continued to increase? relative to other countries. mr. quinones: part of it bears noting part of that is because a lot of the countries don't use enough of these drugs. people die in horrible agony from cancer when they shouldn't

be. there is a proper role for these drugs and inhuman medicine and distrust the debate over what that role is is a very, very important one and up to now in the last 20, 25 years in the country, the proper role would appear to be a bottle in every medicine cabinet and that is where he got into trouble. senator murkowski: thank you. thank you mr. chairman. >> mr. quinones, if i need to make a couple of quick observations about her testimony had been one of your space shot marshall plans ideas. listening to this, one thought i had is with your family here especially as i mentioned before, you should be glad you were not nominated for some think were some senator would have kissed you under the table and confused using the process. we thoroughly benefited from your testimony. it strikes me that with your book and with her testimony you may be helping to lead a revolution in a different direction than the one you describe in your book.

when people, as you say -- mostly well-meaning, but a whole variety of participants, some not so well-meaning, mexican drug dealers and enterprising armistice and doctors who thought they were doing the caused ands, all over perception and use of opiates that now there are some relatively simple steps that we can take to move back from the other direction. it takes being aware from that. i mentioned yesterday, if you have all of the heads of the university and institutes and training physicians in tennessee, one of the leading states for this problem working together with the governor to change the way they teach doctors on what to do about opioids. you have many prescriptions of three days worth instead of 60.

there are some steps that we can take and i congratulate you for that. on your testimony, you demonstrated some humility and you don't claim to know everything. we find around here that's a very useful attribute because we don't know everything either. helps hear from you and second you are wonderful storyteller. he reminds me of my friend alex haley who wrote "roots" and he told me after he made his speech he said men make a suggestion . if when you begin you would say may i tell you a story instead of making a speech? someone might ask and listen to what you have to say so because of your storytelling we listen to what you have to say. finally, on the marshall plan and the space shot i think senator murray and murkowski worked together fixed "no child left behind" a couple of years ago. one of the things "no child left behind" in education is have as a goal 100% of children would be proficient in reading and math by the year 2014 and i remember

when that was set i was not in the senate and i thought i guess that's all right. we say all people are created equal and samuel huntington a professor at harvard said most of our politics is about setting high goals for ourselves so we never reach in dealing with the consequences of not having reached them. that is sort of what we do as a country. then i was thinking about a created a lot of problems for us and the consequences that were attached to that. on the marshall plan and this they shot i think it might be more like the marshall plan. the space shot was a high goal and inspired everybody but it was done from washington. he was essentially organized single shot efforts and the marshall plan actually was a request of european countries to come up with their own plan.

it wasn't marshall's plan or president truman's plan. those countries came up with a plan and we funded it but then they implemented it and some succeeded more than others. it's probably what will happen here. some sort of hide whole but i think the better example may be the marshall plan. mr. quinones: you may be right. >> each of the states are different and i like the fact that you talk about parts of the country that are ravaged by a globalization and on line purchasing and leaving main streets empty and people without things to do but then we have charlotte and nashville. the complex problem and you've helped us understand it. thank you for your leadership and we appreciate your family coming as well, all the way from los angeles.

senator murray, anything else? the hearing record will remain open for 10 days. members may submit additional information to the record within that time if they would like. the committee will meet again on thursday, january 11 for the executive session on nominations, thank you for being here. the committee will stand adjourned. [inaudible conversations] [captions copyright national cable satellite corp. 2018] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

[inaudible conversations] [inaudible conversations]

heardlier this week, we more about opioids action, as president trump signed a bill into law that aims to stop the flow of the synthetic opioid fentanyl into the u.s.